Effects of Parkinson's disease on optimization and structure of variance in multi-finger tasks

Hierarchical Organization and Adjustment of Force Coordination in Response to Self-Triggered and External-Triggered Cues in Simulated Archery Performance

The purpose of this study was to investigate the hierarchical organization of digit force production and its effect on stability and performance during the simulated archery task. The simulated archery shooting task required the production of a prescribed level of force in virtual space with the left hand and an equivalent force with all 4 fingers of right hand. A single trial had 2 phases, including static force production as aiming in archery and quick force release to shoot the virtual arrow. The timing of the force release was determined by the participant's choice or response to the external cue. The coordination indices, that is, the synergy index, of force stabilization were quantified in 2 hierarchies by decomposing the variance components. The accuracy and precision of the hit position of the virtual arrow were calculated as performance-related indices. The results confirmed that the precision, that is, reproducibility, of the performance was greater when the force release time was determined by the self-selected time, suggesting the beneficial effect of the anticipatory mechanism. There was a distinct synergistic organization of digit forces for the stabilization of net forces in both bimanual and multifinger levels, which was especially correlated with the precision of performance.

Multi-muscle synergies in preparation for gait initiation in Parkinson's disease

OBJECTIVE

We investigated changes in indices of muscle synergies prior to gait initiation and the effects of gaze shift in patients with Parkinson's disease (PD). A long-term objective of the study is to develop a method for quantitative assessment of gait-initiation problems in PD.

METHODS

PD patients without clinical signs of postural instability and two control groups (age-matched and young) performed a gait initiation task in a self-paced manner, with and without a quick prior gaze shift produced by turning the head. Muscle groups with parallel scaling of activation levels (muscle modes) were identified as factors in the muscle activation space. Synergy index stabilizing center of pressure trajectory in the anterior-posterior and medio-lateral directions (indices of stability) was quantified in the muscle mode space. A drop in the synergy index in preparation to gait initiation (anticipatory synergy adjustment, ASA) was quantified.

RESULTS

Compared to the control groups, PD patients showed significantly smaller synergy indices and ASA for both directions of the center of pressure shift. Both PD and age-matched controls, but not younger controls, showed detrimental effects of the prior gaze shift on the ASA indices.

CONCLUSIONS

PD patients without clinically significant posture or gait disorders show impaired stability of the center of pressure and its diminished adjustment during gait initiation.

SIGNIFICANCE

The indices of stability and ASA may be useful to monitor pre-clinical gait disorders, and lower ASA may be relevant to emergence of freezing of gait in PD.

Optimality, Stability, and Agility of Human Movement: New Optimality Criterion and Trade-Offs

This review of movement stability, optimality, and agility is based on the theory of motor control with changes in spatial referent coordinates for the effectors, the principle of abundance, and the uncontrolled manifold hypothesis. A new optimality principle is suggested based on the concept of optimal sharing corresponding to a vector in the space of elemental variables locally orthogonal to the uncontrolled manifold. Motion along this direction is associated with minimal components along the relatively unstable directions within the uncontrolled manifold leading to a minimal motor equivalent motion. For well-practiced actions, this task-specific criterion is followed in spaces of referent coordinates. Consequences of the suggested framework include trade-offs among stability, optimality, and agility, unintentional changes in performance, hand dominance, finger specialization, individual traits in performance, and movement disorders in neurological patients.

Higher visual gain contributions to bilateral motor synergies and force control

This study investigated the effects of altered visual gain levels on bilateral motor synergies determined by the uncontrolled manifold (UCM) hypothesis and force control. Twelve healthy participants performed bimanual index finger abduction force control tasks at 20% of their maximal voluntary contraction across four different visual gain conditions: 8, 80, 256, and 512 pixels/N. Quantifying force accuracy and variability within a trial provided a bimanual force control outcome. The UCM analysis measured bilateral motor synergies, a proportion of good variance to bad variance across multiple trials. Correlation analyses determined whether changes in the UCM variables were related to changes in force control variables from the lowest to highest visual gain conditions, respectively. Multiple analyses indicated that the three highest visual gain conditions in comparison to the lowest visual gain increased values of bilateral motor synergies and target force accuracy. The correlation findings showed that a reduction of bad variance from the lowest to three highest visual gain conditions was related to increased force accuracy. These findings reveal that visual gain greater than 8 pixels/N facilitates bimanual force control.

Coordination in adults with neurological impairment - A systematic review of uncontrolled manifold studies

BACKGROUND

Analysis of sensorimotor synergies has been greatly advanced by the Uncontrolled Manifold (UCM) approach. The UCM method is based on partitioning inter-trial variance displayed by elemental variables into 'good' (V_UCM) and 'bad' (V_ORT) variability that, respectively, indicate maintenance or loss of task stability. In clinical populations, these indices can be used to investigate the strength, flexibility, stereotypy and agility of synergistic control.

RESEARCH QUESTION

How are synergies affected by neurological impairment in adults? Specifically, this study aimed to determine i) the impact of pathology on V_UCM, V_ORT, and their ratio (synergy index); ii) the relationship between synergy indices and functional performance; iii) changes in anticipatory synergy adjustments (ASAs); and iv) the effects of interventions on synergies.

METHODS

Systematic review of UCM studies on adults with neurological impairment.

RESULTS

Most of the 17 studies had moderate to high quality scores in the adapted Critical Review Form and the UCM reporting quality checklist developed for this review. i) Most of the studies found reduced synergy indices for patients with Parkinson's disease (PD), olivo-ponto-cerebellar atrophy, multiple sclerosis and spinocerebellar degeneration, with variable levels of change in V_UCM and V_ORT. Reduction in synergy indices was not as consistent for stroke, in three out of six studies it was unchanged. ii) Five of seven studies found no significant correlations between scores on motor function scales and UCM indices. iii) Seven studies consistently reported ASAs that are smaller in magnitude, delayed, or both, for patients compared to healthy controls. iv) Two studies reported increased synergy indices, either via increase in V_UCM or decrease in V_ORT, after dopaminergic drugs for patients with PD. There were similar synergy indices but improved ASAs after deep brain stimulation for patients with PD.

SIGNIFICANCE

UCM can provide reliable and sensitive indicators of altered synergistic control in adults with neurological impairment.

Changing one's focus of attention alters the structure of movement variability

Substantial evidence supports the beneficial effect of an external (vs. internal) focus of attention on task performance during goal-directed movements. Counter-intuitively, an external focus has also been shown to increase joint-level movement variability.

OBJECTIVE

To determine whether shifting attentional focus can alter the structure of movement variability, thereby offering a probable mechanistic explanation for how adopting an external focus of attention might confer its benefits.

METHODS

Thirty-five healthy adults (age 23-55) performed unipedal hopping under three different attentional foci: natural (no directed focus), internal focus, and external focus. Uncontrolled manifold analysis was used to examine the structure of movement variability with respect to stabilization of leg orientation and vertical leg length during hopping. Takeoff/landing event bin and stance phase integrals of performance-irrelevant and performance-destabilizing variability were compared across focus conditions.

RESULTS

Accuracy of hopping in place improved with both external and internal foci compared to the natural condition (.004 ≤ p ≤ .035). External focus, to a greater degree than internal focus, destabilized leg orientation at takeoff and landing compared to the natural condition (.001 ≤ p ≤ .038). External focus increased - but internal focus decreased - leg length stabilization throughout stance compared to the natural condition (p < .001).

CONCLUSION

External focus was superior to internal and natural focus conditions in terms of increasing flexibility within the system to orient the leg differently at takeoff and landing to compensate for unintentional drift during hopping. An external focus increased leg length stabilization in stance by preferentially increasing the subset of variability that explores multiple successful performance options. These results provide an understanding of the mechanism underlying external focus benefits - improving movement variability/coordination.

Effect of Kinetic Degrees of Freedom on Multi-Finger Synergies and Task Performance during Force Production and Release Tasks

Complex structures present in a human body has relatively large degrees-of-freedom (DOFs) as compared to the requirement of a particular task. This phenomenon called motor redundancy initially deemed as a computational problem rather can be understood as having the flexibility to perform the certain task successfully. Hence, the purpose of our study was to examine the positive impact of extra DOFs (redundant DOFs) during force production tasks. For this purpose, an experimental setup was designed to simulate archery-like shooting, and purposeful organization of a redundant set of finger forces determined the stability of important performance variables as well as accurate and precise performance. DOFs were adjusted by changing the number of fingers explicitly involved in the task. The concept of motor synergy and computational framework of uncontrolled manifold (UCM) approach was used to quantify stability indices during finger force production. As a result, accuracy and precision of the task improved with an increase in DOFs. Also, the stability indices of net finger forces and moment increased with active DOFs of fingers. We concluded that the controller actively utilizes extra DOFs to increase the stability of the performance, which is associated with the improved accuracy and precision of the task.

Long-term effects of mild traumatic brain injuries to oculomotor tracking performances and reaction times to simple environmental stimuli

Understanding the long-term effects of concussive events remains a challenge for the development of modern medical practices and the prevention of recurrent traumas. In this study, we utilized indices of oculomotor performance and the ability to react to simple environmental stimuli to assess the long-term motor effects of traumatic brain injury in its mildest form (mTBI). We performed analysis of eye movement accuracy, investigated the presence of abnormal eye movements, and quantified time to react to simple environmental stimuli on long-term mTBI survivors. Results indicated the presence of impairments to basic neural functions used to explore and respond to environmental demands long after the occurrence of mTBIs. Specifically, the result revealed the presence of abnormal saccadic eye movements while performing horizontal smooth pursuit, diminished accuracy of primary saccadic horizontal eye movement, and a widespread slower reaction to both visual and auditory stimuli. The methodology used in this study indicated to be potentially useful in aiding future investigations of neural circuitry impaired by mTBI and provide indices of recovery in future clinical trials testing mTBI-related clinical interventions.

Development of finger force coordination in children

Coordination is often observed as body parts moving together. However, when producing force with multiple fingers, the optimal coordination is not to produce similar forces with each finger, but rather for each finger to correct mistakes of other fingers. In this study, we aim to determine whether and how this skill develops in children aged 4-12 years. We measured this sort of coordination using the uncontrolled manifold hypothesis (UCM). We recorded finger forces produced by 60 typically developing children aged between 4 and 12 years in a finger-pressing task. The children controlled the height of an object on a screen by the total amount of force they produced on force sensors. We found that the synergy index, a measure of the relationship between "good" and "bad" variance, increased linearly as a function of age. This improvement was achieved by a selective reduction in "bad" variance rather than an increase in "good" variance. We did not observe differences between males and females, and the synergy index was not able to predict outcomes of upper limb behavioral tests after controlling for age. As children develop between the ages of 4 and 12 years, their ability to produce negative covariation between their finger forces improves, likely related to their improved ability to perform dexterous tasks.

Synergies and Motor Equivalence in Voluntary Sway Tasks: The Effects of Visual and Mechanical Constraints

The authors used two analyses developed within the framework of the uncontrolled manifold hypothesis to quantify multimuscle synergies during voluntary body sway: analysis of intertrial variance and analysis of motor equivalence with respect to the center of pressure (COP) trajectory. Participants performed voluntary sway tasks in the anteroposterior direction at 0.33 and 0.66 Hz. Muscle groups were identified in the space of muscle activations and used as elemental variables in the synergy analyses. Changing mechanical and vision feedback-based constraints led to significant changes in indices of sway performance such as COP deviations in the uninstructed, mediolateral direction and indices of spontaneous postural sway. In contrast, there were no significant effects on synergy indices. These findings show that the neural control of performance and of its stability may involve different control variables and neurophysiological structures. There were strong correlations between the indices of motor equivalence and those computed using the intercycle variance analysis. This result is potentially important for studies of patients with movement disorders who may be unable to perform multiple trials (cycles) at any given task, making analysis of motor equivalence of single trials a viable alternative to explore changes in stability of actions.

Motor equivalence and structure of variance: multi-muscle postural synergies in Parkinson's disease

We explored posture-stabilizing multi-muscle synergies with two methods of analysis of multi-element, abundant systems: (1) Analysis of inter-cycle variance; and (2) Analysis of motor equivalence, both quantified within the framework of the uncontrolled manifold (UCM) hypothesis. Data collected in two earlier studies of patients with Parkinson's disease (PD) were re-analyzed. One study compared synergies in the space of muscle modes (muscle groups with parallel scaling of activation) during tasks performed by early-stage PD patients and controls. The other study explored the effects of dopaminergic medication on multi-muscle-mode synergies. Inter-cycle variance and absolute magnitude of the center of pressure displacement across consecutive cycles were quantified during voluntary whole-body sway within the UCM and orthogonal to the UCM space. The patients showed smaller indices of variance within the UCM and motor equivalence compared to controls. The indices were also smaller in the off-drug compared to on-drug condition. There were strong across-subject correlations between the inter-cycle variance within/orthogonal to the UCM and motor equivalent/non-motor equivalent displacements. This study has shown that, at least for cyclical tasks, analysis of variance and analysis of motor equivalence lead to metrics of stability that correlate with each other and show similar effects of disease and medication. These results show, for the first time, intimate links between indices of variance and motor equivalence. They suggest that analysis of motor equivalence, which requires only a handful of trials, could be used broadly in the field of motor disorders to analyze problems with action stability.

Welding-related brain and functional changes in welders with chronic and low-level exposure

Although an essential nutrient, manganese (Mn) can be toxic at high doses. There is, however, uncertainty regarding the effects of chronic low-level Mn-exposure. This review provides an overview of Mn-related brain and functional changes based on studies of a cohort of asymptomatic welders who had lower Mn-exposure than in most previous work. In welders with low-level Mn-exposure, we found: 1) Mn may accumulate in the brain in a non-linear fashion: MRI R1 (1/T1) signals significantly increased only after a critical level of exposure was reached (e.g., ≥300 welding hours in the past 90days prior to MRI). Moreover, R1 may be a more sensitive marker to capture short-term dynamic changes in Mn accumulation than the pallidal index [T1-weighted intensity ratio of the globus pallidus vs. frontal white matter], a traditional marker for Mn accumulation; 2) Chronic Mn-exposure may lead to microstructural changes as indicated by lower diffusion tensor fractional anisotropy values in the basal ganglia (BG), especially when welding years exceeded more than 30 years; 3) Mn-related subtle motor dysfunctions can be captured sensitively by synergy metrics (indices for movement stability), whereas traditional fine motor tasks failed to detect any significant differences; and 4) Iron (Fe) also may play a role in welding-related neurotoxicity, especially at low-level Mn-exposure, evidenced by higher R2* values (an estimate for brain Fe accumulation) in the BG. Moreover, higher R2* values were associated with lower phonemic fluency performance. These findings may guide future studies and the development of occupation- and public health-related polices involving Mn-exposure.

Optimality and stability of intentional and unintentional actions: I. Origins of drifts in performance

We address the nature of unintentional changes in performance in two papers. This first paper tested a hypothesis that unintentional changes in performance variables during continuous tasks without visual feedback are due to two processes. First, there is a drift of the referent coordinate for the salient performance variable toward the actual coordinate of the effector. Second, there is a drift toward minimum of a cost function. We tested this hypothesis in four-finger isometric pressing tasks that required the accurate production of a combination of total moment and total force with natural and modified finger involvement. Subjects performed accurate force-moment production tasks under visual feedback, and then visual feedback was removed for some or all of the salient variables. Analytical inverse optimization was used to compute a cost function. Without visual feedback, both force and moment drifted slowly toward lower absolute magnitudes. Over 15 s, the force drop could reach 20% of its initial magnitude while moment drop could reach 30% of its initial magnitude. Individual finger forces could show drifts toward both higher and lower forces. The cost function estimated using the analytical inverse optimization reduced its value as a consequence of the drift. We interpret the results within the framework of hierarchical control with referent spatial coordinates for salient variables at each level of the hierarchy combined with synergic control of salient variables. The force drift is discussed as a natural relaxation process toward states with lower potential energy in the physical (physiological) system involved in the task.

The synergic control of multi-finger force production: stability of explicit and implicit task components

Manipulating objects with the hands requires the accurate production of resultant forces including shear forces; effective control of these shear forces also requires the production of internal forces normal to the surface of the object(s) being manipulated. In the present study, we investigated multi-finger synergies stabilizing shear and normal components of force, as well as drifts in both components of force, during isometric pressing tasks requiring a specific magnitude of shear force production. We hypothesized that shear and normal forces would evolve similarly in time and also show similar stability properties as assessed by the decomposition of inter-trial variance within the uncontrolled manifold hypothesis. Healthy subjects were required to accurately produce total shear and total normal forces with four fingers of the hand during a steady-state force task (with and without visual feedback) and a self-paced force pulse task. The two force components showed similar time profiles during both shear force pulse production and unintentional drift induced by turning the visual feedback off. Only the explicitly instructed components of force, however, were stabilized with multi-finger synergies. No force-stabilizing synergies and no anticipatory synergy adjustments were seen for the normal force in shear force production trials. These unexpected qualitative differences in the control of the two force components-which are produced by some of the same muscles and show high degree of temporal coupling-are interpreted within the theory of control with referent coordinates for salient variables. These observations suggest the existence of two classes of neural variables: one that translates into shifts of referent coordinates and defines changes in magnitude of salient variables, and the other controlling gains in back-coupling loops that define stability of the salient variables. Only the former are shared between the explicit and implicit task components.

Synergy as a new and sensitive marker of basal ganglia dysfunction: A study of asymptomatic welders

BACKGROUND

Multi-digit synergies, a recently developed, theory-based method to quantify stability of motor action, are shown to reflect basal ganglia dysfunction associated with parkinsonian syndromes. In this study, we tested the hypothesis that multi-digit synergies may capture early and subclinical basal ganglia dysfunction. We chose asymptomatic welders to test the hypothesis because the basal ganglia are known to be most susceptible to neurotoxicity caused by welding-related metal accumulation (such as manganese and iron).

METHODS

Twenty right-handed welders and 13 matched controls were invited to perform single- and multi-finger pressing tasks using the fingers of the right or left hand. Unified Parkinson's Disease Rating Scale and Grooved Pegboard scores were used to gauge gross and fine motor dysfunction, respectively. High-resolution (3T) T1-weighted, T2-weighted, T1 mapping, susceptibility, and diffusion tensor MRIs were obtained to reflect manganese, iron accumulation, and microstructural changes in basal ganglia. The synergy index stabilizing total force and anticipatory synergy adjustments were computed, compared between groups, and correlated with estimates of basal ganglia manganese [the pallidal index, R1 (1/T1)], iron [R2* (1/T2*)], and microstructural changes [fractional anisotropy and mean diffusivity].

RESULTS

There were no significant differences in Unified Parkinson's Disease Rating Scale (total or motor subscale) or Grooved Pegboard test scores between welders and controls. The synergy index during steady-state accurate force production was decreased significantly in the left hand of welders compared to controls (p=0.004) but did not reach statistical significance in the right hand (p=0.16). Anticipatory synergy adjustments, however, were not significantly different between groups. Among welders, higher synergy indices in the left hand were associated significantly with higher fractional anisotropy values in the left globus pallidus (R=0.731, p<0.001) but not with the pallidal index, R1, or R2* values in the basal ganglia.

CONCLUSIONS

These data suggest that multi-digit synergy metrics may serve as preclinical markers for basal ganglia dysfunction in welders and other populations at risk for neurodegenerative diseases involving parkinsonian symptoms. This finding may have important clinical, scientific, and public/occupational health implications.

Analytical Inverse Optimization in Two-Hand Prehensile Tasks

The authors explored application of analytical inverse optimization (ANIO) method to the normal finger forces in unimanual and bimanual prehensile tasks with discrete and continuously changing constraints. The subjects held an instrumented handle vertically with one or two hands. The external torque and grip force changed across trials or within a trial continuously. Principal component analysis showed similar percentages of variance accounted for by the first two principal components across tasks and conditions. Compared to unimanual tasks, bimanual tasks showed significantly more frequent inability to find a cost function leading to a stable solution. In cases of stable solutions, similar second-order polynomials were computed as cost functions across tasks and condition. The bimanual tasks, however, showed significantly worse goodness-of-fit index values. The authors show that ANIO can be used in tasks with slowly changing constraints making it an attractive tool to study optimality of performance in special populations. They also show that ANIO can fail in multifinger tasks, likely due to irreproducible behavior across trials, more likely to happen in bimanual tasks compared to unimanual tasks.

On the nature of unintentional action: a study of force/moment drifts during multifinger tasks

We explored the origins of unintentional changes in performance during accurate force production in isometric conditions seen after turning visual feedback off. The idea of control with referent spatial coordinates suggests that these phenomena could result from drifts of the referent coordinate for the effector. Subjects performed accurate force/moment production tasks by pressing with the fingers of a hand on force sensors. Turning the visual feedback off resulted in slow drifts of both total force and total moment to lower magnitudes of these variables; these drifts were more pronounced in the right hand of the right-handed subjects. Drifts in individual finger forces could be in different direction; in particular, fingers that produced moments of force against the required total moment showed an increase in their forces. The force/moment drift was associated with a drop in the index of synergy stabilizing performance under visual feedback. The drifts in directions that changed performance (non-motor equivalent) and in directions that did not (motor equivalent) were of about the same magnitude. The results suggest that control with referent coordinates is associated with drifts of those referent coordinates toward the corresponding actual coordinates of the hand, a reflection of the natural tendency of physical systems to move toward a minimum of potential energy. The interaction between drifts of the hand referent coordinate and referent orientation leads to counterdirectional drifts in individual finger forces. The results also demonstrate that the sensory information used to create multifinger synergies is necessary for their presence over the task duration.

Impaired synergic control of posture in Parkinson's patients without postural instability

BACKGROUND

Postural instability is one of most disabling motor symptoms in Parkinson's disease. Indices of multi-muscle synergies are new measurements of movement and postural stability.

OBJECTIVES

Multi-muscle synergies stabilizing vertical posture were studied in Parkinson's disease patients without clinical symptoms of postural instability (Hoehn-Yahr ≤ II) and age-matched controls. We tested the hypothesis that both synergy indices during quiet standing and synergy adjustments to self-triggered postural perturbations would be reduced in patients.

METHODS

Eleven Parkinson's disease patients and 11 controls performed whole-body tasks while standing. Surface electromyography was used to quantify synergy indices stabilizing center of pressure shifts in the anterior-posterior direction during a load-release task.

RESULTS

Parkinson's disease patients showed a significantly lower percentage of variance in the muscle activation space accounted for by the first four principal components, significantly reduced synergy indices during steady state, and significantly reduced anticipatory synergy adjustments (a drop in the synergy index prior to the self-triggered unloading).

CONCLUSIONS

The study demonstrates for the first time that impaired synergic control in Parkinson's disease can be quantified in postural tasks, even in patients without clinical manifestations of postural instability. Synergy measurements may provide a biomarker sensitive for early problems with postural stability in Parkinson's disease.

Effects of unilateral stroke on multi-finger synergies and their feed-forward adjustments

We explored the changes in multi-finger synergies in patients after a single cortical stroke with mild motor impairments. We hypothesized that both synergy indices and anticipatory synergy adjustments prior to the initiation of a self-paced quick action would be diminished in the patients compared to age-matched controls. The patients with history of cortical stroke, and age-matched controls (n=12 in each group) performed one-finger and multi-finger accurate force production tasks involving both steady-state and quick force pulse production. Finger interdependence (enslaving) and multi-finger synergies stabilizing total force were quantified. The stroke patients showed lower maximal finger forces, in particular in the contralesional hand, which also showed increased enslaving indices. Multi-finger synergies during steady-state force production were, however, unchanged after stroke. In contrast, a drop in the synergy index prior to the force pulse generation was significantly delayed in the stroke patients. Our results show that mild cortical stroke leads to no significant changes in multifinger synergies, but there is impairment in feed-forward adjustments of the synergies prior to a quick action, a drop in the maximal force production, and an increase in enslaving. We conclude that studies of synergies reveal two aspects of synergic control differentially affected by cortical stroke.

Finger force changes in the absence of visual feedback in patients with Parkinson's disease

OBJECTIVES

We investigated the unintentional drift in total force and in sharing of the force between fingers in two-finger accurate force production tasks performed without visual feedback by patients with Parkinson's disease (PD) and healthy controls. In particular, we were testing a hypothesis that adaptation to the documented loss of action stability could lead to faster force drop in PD.

METHODS

PD patients and healthy controls performed accurate constant force production tasks without visual feedback by different finger pairs, starting with different force levels and different sharing patterns of force between the two fingers.

RESULTS

Both groups showed an exponential force drop with time and a drift of the sharing pattern towards 50:50. The PD group showed a significantly faster force drop without a change in speed of the sharing drift. These results were consistent across initial force levels, sharing patterns, and finger pairs. A pilot test of four subjects, two PD and two controls, showed no consistent effects of memory on the force drop.

CONCLUSIONS

We interpret the force drop as a consequence of back-coupling between the actual and referent finger coordinates that draws the referent coordinate towards the actual one. The faster force drop in the PD group is interpreted as adaptive to the loss of action stability in PD. The lack of group differences in the sharing drift suggests two potentially independent physiological mechanisms contributing to the force and sharing drifts.

SIGNIFICANCE

The hypothesis on adaptive changes in PD with the purpose to ensure stability of steady states may have important implications for treatment of PD. The speed of force drop may turn into a useful tool to quantify such adaptive changes.

Neural control of movement stability: Lessons from studies of neurological patients

The concept of synergy provides a theoretical framework for movement stability resulting from the neural organization of multiple elements (digits, muscles, etc.) that all contribute to salient performance variables. Although stability of performance is obviously important for steady-state tasks leading to high synergy indices, a feed-forward drop in synergy indices is seen in preparation to a quick action (i.e., anticipatory synergy adjustments, ASAs). We review recent studies of multi-finger and multi-muscle synergies that show decreased indices of synergies and ASAs in patients with Parkinson's disease (PD) or multisystem atrophy. In PD, the impairments in synergies and ASAs are partially reversed by dopaminergic drugs, and changes in synergy indices are present even in PD patients at earliest diagnosis. Taken together, these results point at subcortical structures that are crucial for proper control of movement stability. It is timely to introduce the concept of impaired control of stability as an objective, quantifiable, and theory-based clinical descriptor of movement disorders that can increase our understanding of the neural control of movement with all of its implications for clinical practice.

Prehension synergies and hand function in early-stage Parkinson's disease

We explored the multi-digit synergies and hand performance in object manipulations and pressing tasks in patients with early-stage Parkinson's disease (PD) and healthy controls. Synergies were defined as inter-trials co-variation patterns among forces/moments produced by individual digits that stabilized a resultant mechanical variable. The subjects performed three main tasks: pressing (steady-state force production followed by a force pulse into the target), prehension (manipulation of a handheld instrumented handle imitating the action of taking a sip from a glass), and functional object manipulation (moving a glass with water as quickly and accurately as possible along a chain of targets). The PD patients were slower compared to controls in all three tasks. Patients showed smaller synergy indices in the pressing and prehension tasks. In the prehension tasks, patients showed elevated grip force at steady states with smaller grip force modulation during the handle motion. PD patients showed smaller feed-forward synergy adjustments in preparation to the quick action in the pressing and (to a smaller degree) prehension tasks. Synergy indices correlated with the time index of performance in the functional glass-with-water task, whereas none of the indices correlated with the Unified PD Rating Scale part III-motor scores. We interpret the results as pointing at an important role of subcortical structures in motor synergies and their feed-forward adjustments to action.